Legislative Updates
Ballot Initiative Regarding Medicaid Minimum Reimbursement Fee

Dr. Garry Van Genderen, a Colorado dentist, has proposed a ballot initiative to the State of Colorado regarding Medicaid Reimbursement. The initiative has passed Title Board and is in the process of collecting signatures.

This is not a Colorado Dental Association ballot initiative, however, we know Medicaid reimbursement is an important topic to our members and we wanted to make you aware of Proposed Initiative #82.

If you are interested in signing the ballot petition or collecting signatures, please contact Dr. Van Genderen directly at 201-214-3838 or GarryVanGenderen@gmail.com.

The title as designed and fixed by the Ballot Title Setting Board is as follows:
  • A change to the Colorado Revised Statutes concerning the establishment of a minimum reimbursement fee for covered Medicaid dental procedures performed by Medicaid providers in Colorado at a rate that is equal to or greater than the lowest tenth percentile of the fees charged nationally according to the most recent version of the "Survey of Dental Fees" published by the American Dental Association
SB22-219, the Dental Therapy Bill Passes Through Senate, Progresses in House
 
The Dental Therapy Bill passed nearly unanimously (32-3) out of the Senate on Monday. Shortly before midnight last night it was introduced in the House. Today it passed through the House Finance Committee (8-3), bypassing the House Health and Insurance Committee, and passed through the House Appropriations Committee (8-3). It is expected to progress through second and third readings in the House tomorrow or Monday.
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Background:
Three weeks ago, SB22-219 was introduced in the Colorado legislature as a bill.

This bill was proposed by Healthier Colorado, a health advocacy group, and has significant sponsorship by Senate Majority Leader Dominick Moreno, Senate Minority Caucus Chair Jim Smallwood and House Majority Whip Monica Duran. It is being supported by numerous consumer, public health and oral health stakeholders.

In December, when the CDA notified membership about a dental therapy bill draft, the CDA Government Relations Council, which is composed of volunteer dentists, was tasked with reviewing the draft and evaluating next steps while taking into consideration the current political climate around this topic.

The first draft of this bill lacked reasonable requirements for education, supervision and scope allowances. It was drafted without dental provider input or stakeholder engagement.

Knowing this bill had significant backing from key members of legislative leadership and would be introduced and proceed with or without the CDA’s input and experience of our members, the CDA could not successfully stand in opposition. The CDA Government Relations Council voted to voice its substantial concerns about the bill to proponents and work to prevent an irresponsible bill draft from being introduced that could have a negative effect on patent safety and quality of care.

Hundreds of dentist hours were spent reviewing, revising, meeting about and negotiating the dental therapy bill draft.

The following chart provides highlights of the progress the council was able to achieve from the original bill draft to the negotiated bill.
Original
Negotiated
Education
Open-ended Dental Board approval process for accepting dental therapy education tracks. Allowance for “any other program the board approves that is not accredited”
  • Included occupational portability provisions that might have allowed dental therapists to transfer licenses from other states without equivalent training and education  
Allows only accredited training

Removed occupational portability provisions 
Supervision
Independent practice, billing and advertising
Ensures a supervised and team-based practice model; eliminated independent practice
  • Added up to 1000 preceptorship hours related to advanced procedures under direct supervision before transition to ongoing indirect supervision with a collaborative agreement
  • Eliminated separate practice ownership
  • Removed independent advertising
  • Removed direct billing 
Scope
One of the broadest proposed scopes among all state legislative proposals

Prescribing of narcotics

Allowed open-ended scope provisions allowing “other services and functions” or those permitted by the Dental Board in rule
Scales back scope of practice significantly
  • Narrowed scope to remove several advanced procedures
  • Eliminated prescribing of narcotics
  • Eliminated open ended board-allowed scope provisions 
Dental Board Composition
More non-dentists than dentists on the dental board

Diversity and qualification criteria added for DDS/RDH members

Implementation dates misaligned
Ensures that dentists maintain a majority on the dental board and adjusted qualifications for dental therapist board members to ensure quality candidates serving
Safety & Accountability
Unclear liability coverage provisions
Added liability coverage requirements equivalent to those for dentists, increased disciplinary fine levels (originally aligned with dental hygienists)
Access
Legislator and stakeholder commitments to working jointly on a priority 2023 CDA bill to increase dental care and access
With the substantial changes made to the original draft bill, the CDA maintains a neutral position on this bill.